Basic Information
| Provider Information | |||||||||
| NPI: | 1922003219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOAK | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 MATTHEW ST | ||||||||
| Address2: | SUITE B-1 | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457501644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403765501 | ||||||||
| FaxNumber: | 7403765506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 01/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 20854 | WV | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 2086S0122X | 35085183 | OH | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2332185 | 05 | OH | MEDICAID | P00183591 | 01 | OH | RRMCR | OTHER | 1808469000 | 05 | WV | MEDICAID | 000000351124 | 01 | OH | ANTHEM | OTHER |